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   In shortening the length of stay for patients in almost every venue, this process can save a substantial amount of money for the government, but at what cost for many patients?

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The average length of stay (ALOS) in hospitals, Long Term Acute Care Hospitals (LTACHs), and rehab hospitals is trending shorter and shorter.  Medicare (MCR) along with insurance companies (managed care) that contract with MCR has set their sites on shorter stays to decrease spending.  They have, in essence, created a grading rubric that ALOS is 85% of the grade. This leaves all providers and clinicians with little say as to whether the patient discharges at the appropriate time. The days of sending a patient to a rehabilitation hospital where they can receive aggressive therapy while also being medically taken care of are going away (“Length-of-Hospital”, 2017).

In mandating short stays in hospitals and not approving LTACHs and rehabilitation hospitals, one might presume that this is good for skilled nursing facilities (SNF), but that would be wrong because they have now demanded short stays in SNFs as well.  One insurance company has now mandated that a SNF has to have a patient on their service out in 17 days. In dealing with these issues daily this seems to be a trend that will be long-standing as more and more insurance companies are making these demands.

LTACHs are great places for patients to go that are in need of acute care, but for a longer length of time. Originally, LTACHs were seen as the better choice than keeping a patient in an acute hospital due to lower reimbursement. However, MCR has now changed their reimbursement for LTACHs in that the shorter the stay the more reimbursement they can receive (Kim, et al., 2015).

In shortening the length of stay for patients in almost every venue, this process can save a substantial amount of money for the government, but at what cost for many patients? Due to the rules on short stays, nurses and doctors witness patients being discharged sooner than their conditions warrants. The positive side is that SNFs have to increase their skill-set because many patients who would have went to an LTACH or rehabilitation hospital are now being denied by companies, but approved for SNF stays. This puts SNFs in a position because scope of practice laws in each state can limit what can be done in a SNF due to the fact that most nurses in SNFs are Licensed Practical Nurses and very few Registered Nurses. Even though a SNF may see a small increase in census, they are not seeing a raise in reimbursement which makes it difficult to have Registered Nurses in the facility.

There are so many aspects to these changes that many people do not know or understand, but the bottom line is the outcome of patients while trying to keep costs manageable.

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